NR607 Exam 3 Actual Exam Style V1 | NR
607 Diagnosis & Management in
Psychiatric-Mental Health III Practicum |
Chamberlain
1. A 65-year-old patient presents with acute onset of confusion, visual hallucinations, and
fluctuating levels of consciousness. Which of the following is the most likely diagnosis?
A. Delirium
B. Alzheimer’s Disease
C. Schizophrenia
D. Vascular Dementia
Answer: A
Rationale: Delirium is characterized by an acute onset and fluctuating course of symptoms,
particularly impairment in attention and consciousness. Unlike dementia, which is
progressive and stable, delirium is often reversible once the underlying medical cause is
treated. The presence of visual hallucinations in an older adult without a history of
psychosis is highly suggestive of a medical etiology.
2. A patient taking Clozapine presents with a fever, sore throat, and mouth sores. What is the
priority intervention for the PMHNP?
A. Increase the dose of Clozapine
,B. Prescribe an antibiotic for a suspected cold
C. Order an immediate CBC with differential
D. Refer to a dentist for mouth sores
Answer: C
Rationale: Clozapine carries a black box warning for agranulocytosis, which is a severe
decrease in white blood cell count. Symptoms like fever and sore throat can be early signs
of infection due to a lack of neutrophils. An immediate Complete Blood Count (CBC) with
differential is required to check the Absolute Neutrophil Count (ANC) per REMS protocols.
3. Which psychotherapy model is specifically designed for the treatment of Borderline
Personality Disorder and focuses on mindfulness and distress tolerance?
A. Cognitive Behavioral Therapy (CBT)
B. Interpersonal Therapy (IPT)
C. Dialectical Behavior Therapy (DBT)
D. Psychodynamic Therapy
Answer: C
Rationale: Dialectical Behavior Therapy (DBT) was developed by Marsha Linehan
specifically to treat Borderline Personality Disorder. It combines cognitive-behavioral
techniques with concepts from Zen Buddhism, such as mindfulness. The four modules of
,DBT include mindfulness, distress tolerance, emotion regulation, and interpersonal
effectiveness.
4. A patient with Bipolar I Disorder is experiencing a severe manic episode and is currently
taking Lithium. The serum Lithium level is 0.7 mEq/L. What is the most appropriate action?
A. Increase the dose to reach the acute treatment range of 1.0-1.5 mEq/L
B. Decrease the dose to avoid toxicity
C. Maintain the current dose as it is within range
D. Discontinue Lithium and start an SSRI
Answer: A
Rationale: For acute mania, the therapeutic range for Lithium is typically 1.0 to 1.5 mEq/L,
while maintenance levels are usually 0.6 to 1.2 mEq/L. A level of 0.7 mEq/L may be
insufficient to control severe acute manic symptoms. The clinician should consider
increasing the dose while monitoring for signs of toxicity and checking levels frequently.
5. An adolescent presents with persistent irritability and frequent outbursts that are out of
proportion to the situation for at least 12 months. What is the most likely DSM-5 diagnosis?
A. Oppositional Defiant Disorder
B. Major Depressive Disorder
C. Conduct Disorder
D. Disruptive Mood Dysregulation Disorder (DMDD)
, Answer: D
Rationale: Disruptive Mood Dysregulation Disorder (DMDD) was introduced in the DSM-5
to address concerns about the overdiagnosis of Bipolar Disorder in children. It requires a
pattern of severe, recurrent temper outbursts and a persistently irritable mood between
outbursts for at least one year. The diagnosis should not be made for the first time before
age 6 or after age 18.
6. Which of the following symptoms is a hallmark of Serotonin Syndrome and helps
distinguish it from Neuroleptic Malignant Syndrome (NMS)?
A. Muscle rigidity
B. Hyperreflexia and myoclonus
C. Hyperthermia
D. Autonomic instability
Answer: B
Rationale: Serotonin Syndrome is often characterized by hyperreflexia and myoclonus
(twitching), particularly in the lower extremities. In contrast, Neuroleptic Malignant
Syndrome (NMS) typically presents with ‘lead-pipe’ muscle rigidity and bradyreflexia. Both
conditions involve hyperthermia and autonomic instability, making physical exam findings
like reflex response crucial for differentiation.
607 Diagnosis & Management in
Psychiatric-Mental Health III Practicum |
Chamberlain
1. A 65-year-old patient presents with acute onset of confusion, visual hallucinations, and
fluctuating levels of consciousness. Which of the following is the most likely diagnosis?
A. Delirium
B. Alzheimer’s Disease
C. Schizophrenia
D. Vascular Dementia
Answer: A
Rationale: Delirium is characterized by an acute onset and fluctuating course of symptoms,
particularly impairment in attention and consciousness. Unlike dementia, which is
progressive and stable, delirium is often reversible once the underlying medical cause is
treated. The presence of visual hallucinations in an older adult without a history of
psychosis is highly suggestive of a medical etiology.
2. A patient taking Clozapine presents with a fever, sore throat, and mouth sores. What is the
priority intervention for the PMHNP?
A. Increase the dose of Clozapine
,B. Prescribe an antibiotic for a suspected cold
C. Order an immediate CBC with differential
D. Refer to a dentist for mouth sores
Answer: C
Rationale: Clozapine carries a black box warning for agranulocytosis, which is a severe
decrease in white blood cell count. Symptoms like fever and sore throat can be early signs
of infection due to a lack of neutrophils. An immediate Complete Blood Count (CBC) with
differential is required to check the Absolute Neutrophil Count (ANC) per REMS protocols.
3. Which psychotherapy model is specifically designed for the treatment of Borderline
Personality Disorder and focuses on mindfulness and distress tolerance?
A. Cognitive Behavioral Therapy (CBT)
B. Interpersonal Therapy (IPT)
C. Dialectical Behavior Therapy (DBT)
D. Psychodynamic Therapy
Answer: C
Rationale: Dialectical Behavior Therapy (DBT) was developed by Marsha Linehan
specifically to treat Borderline Personality Disorder. It combines cognitive-behavioral
techniques with concepts from Zen Buddhism, such as mindfulness. The four modules of
,DBT include mindfulness, distress tolerance, emotion regulation, and interpersonal
effectiveness.
4. A patient with Bipolar I Disorder is experiencing a severe manic episode and is currently
taking Lithium. The serum Lithium level is 0.7 mEq/L. What is the most appropriate action?
A. Increase the dose to reach the acute treatment range of 1.0-1.5 mEq/L
B. Decrease the dose to avoid toxicity
C. Maintain the current dose as it is within range
D. Discontinue Lithium and start an SSRI
Answer: A
Rationale: For acute mania, the therapeutic range for Lithium is typically 1.0 to 1.5 mEq/L,
while maintenance levels are usually 0.6 to 1.2 mEq/L. A level of 0.7 mEq/L may be
insufficient to control severe acute manic symptoms. The clinician should consider
increasing the dose while monitoring for signs of toxicity and checking levels frequently.
5. An adolescent presents with persistent irritability and frequent outbursts that are out of
proportion to the situation for at least 12 months. What is the most likely DSM-5 diagnosis?
A. Oppositional Defiant Disorder
B. Major Depressive Disorder
C. Conduct Disorder
D. Disruptive Mood Dysregulation Disorder (DMDD)
, Answer: D
Rationale: Disruptive Mood Dysregulation Disorder (DMDD) was introduced in the DSM-5
to address concerns about the overdiagnosis of Bipolar Disorder in children. It requires a
pattern of severe, recurrent temper outbursts and a persistently irritable mood between
outbursts for at least one year. The diagnosis should not be made for the first time before
age 6 or after age 18.
6. Which of the following symptoms is a hallmark of Serotonin Syndrome and helps
distinguish it from Neuroleptic Malignant Syndrome (NMS)?
A. Muscle rigidity
B. Hyperreflexia and myoclonus
C. Hyperthermia
D. Autonomic instability
Answer: B
Rationale: Serotonin Syndrome is often characterized by hyperreflexia and myoclonus
(twitching), particularly in the lower extremities. In contrast, Neuroleptic Malignant
Syndrome (NMS) typically presents with ‘lead-pipe’ muscle rigidity and bradyreflexia. Both
conditions involve hyperthermia and autonomic instability, making physical exam findings
like reflex response crucial for differentiation.
